Estimate of survival of patients admitted to a Palliative Care Unit: A prospective study

Abstract

In a prospective open study, 61 consecutive patients with advanced cancer admitted to a Palliative Care Unit underwent survival estimation by two independent physicians after a complete medical exam performed during the first day of admission. An independent research nurse also assessed each patient during the first day of admission. The assessment included activity, pain, nausea, depression, anxiety, anorexia, dry mouth, dyspnea, dysphagia, weight loss, and cognitive status. After the assessment was completed, patients were followed until discharge or death. In 47 evaluable patients, logistic regression showed a significant correlation between survival and dysphagia, cognitive failure, and weight loss. Accordingly, an "indicator of poor prognosis" was considered to exist in any patient who demonstrated weight loss of 10 kg or more plus cognitive failure (Mini-Mental State Questionnaire less than 24) plus dysphagia to solids or liquids. This indicator had a similar level of sensitivity, specificity, and overall accuracy, and a higher level of significance as compared with the assessment by physician #1 and physician #2, respectively. Our data suggest that three simple determinations, which may be performed by a nurse, can predict survival more or less than 4 wk as well as the assessments of two skilled physicians. These results need to be confirmed in other trials with large numbers of patients. Perhaps confirmation of these results and identification of other prognostic factors will result in staging systems for survival estimation of terminally ill cancer patients.

Quality of life and survival prediction in terminal cancer patients

“…The strong but time-dependent association of low KPS with survival may explain in part why previous work either did not support the prognostic role of performance status in terminal cancer patients 53 or have found performance status independently associated with survival only in patients with shorter life expectancies. 54 The presence or severity of certain symptoms, such as weakness, dyspnea, and anorexia, may help to identify the patients for whom performance status assessments have greater prognostic value.…”

Survival of Medicare Patients after Enrollment in Hospice Programs

“…3,10,34 These studies have been limited, however, by their focus on inpatients, by their exclusion of patients with diagnoses other than cancer, or by their incomplete or short follow-up or small or nonrepresentative samples. Moreover, previous studies of survival among patients in hospices either have neglected the role of diagnosis 33 or have not found a relation between diagnosis and the length of survival after enrollment 34 ; some studies, however, have suggested a relation between certain diagnoses and the timing of patients' referral to hospices. 29,35 The duration of survival after enrollment in a hospice is an important outcome to measure because it is relevant to the quality and cost of care that patients receive at the end of life.…”

“…Previous studies of single hospices, both in the United States and abroad, have found median survival times of 11 to 30 days, [26][27][28][29][30][31][32][33] and those based on data from multiple hospices have found survival times of 25 to 35 days. 3,10,34 These studies have been limited, however, by their focus on inpatients, by their exclusion of patients with diagnoses other than cancer, or by their incomplete or short follow-up or small or nonrepresentative samples.…”

A predictive model for survival in metastatic cancer patients attending an outpatient palliative radiotherapy clinic

“…Nineteen articles were identified which examined the prognostic indicators of survival. They are listed in table 3 ( 7, 1 0, 1 1 , 16,[18][19][20][25][26][27][28][29][30][31][32][33][34][35].…”